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Felt report form for Community Internet Intensity Maps

Did you feel it? Report it here!

You can help provide information about the extent of shaking and damage for earthquakes in Canada. The specific details you may provide will help us determine how your area may respond to future earthquakes.

Please provide as complete address information as possible to help us locate the intensity in your area.

Personal Information Collection Statement

The personal information you provide using the Felt report form for Community Internet Intensity Maps is collected under the authority of the Resources and Technical Surveys Act and will be used by Natural Resources Canada to conduct research into earthquakes in Canada.

Please note that the information you provide using the Felt report form for Community Internet Intensity Maps may be routed through an American or other internationally-based server. However, in the event that this occurs, the information will be deleted from the American or internationally-based server after one week.

There are no legal or administrative consequences for refusing to provide the personal information requested. Under the Privacy Act, you have rights of access to, correction of, and protection of personal information.

The information you provide using this form is described in the following standard Personal Information Bank (PIB): Public Communications - PSU 914. For more information about this PIB and your privacy rights, please consult Info Source: Sources of Federal Government and Employee Information, which is published on the Internet by the Treasury Board of Canada Secretariat at: http://infosource.gc.ca/index-eng.asp.

Where did you feel it?

For other events or historic events, go to the GSC CIIM archive. If you were in the U.S.A. at the time of the earthquake, please go to the USGS earthquake site to locate the appropriate form.

Your location when the earthquake occurred:

Street Address

Nearest Cross Street

City

Province

Country

Postal Code

When was it?

Please fill out as completely as you can:

Date of earthquake

Date (YYYY-MM-DD)

Hour (hh:mm)

Where were you?

While answering all these questions is optional, we encourage you to fill out as many as possible so we can provide a more accurate intensity estimate.

What was your situation during the earthquake?

If you were inside please select the type of building or structure?

If other, please describe

Were you asleep during the earthquake?

If you were asleep, did the earthquake wake you up?

Did others nearby feel the earthquake?

Your experience of the earthquake

How would you best describe the ground shaking?

About how many seconds did the shaking last?

How would you best describe your reaction?

How did you respond?

If other, please describe

Was it difficult to stand or walk?

Earthquake effects

Did you notice the swinging/swaying of doors or hanging objects?

Did you notice creaking or other noises?

Did objects rattle, topple over, or fall off shelves?

Did pictures on walls move or get knocked askew?

Did any furniture or appliances slide, tip over, or become displaced?

Was a heavy appliance (refrigerator or range) affected?

Were free-standing walls or fences damaged?

If you were inside, was there any damage to the building? Check all that apply.

All damage types.

No damageHairline cracks in wallsA few large cracks in wallsMany large cracks in wallsCeiling tiles or lighting fixtures fellCracks in chimneyOne or several cracked windowsMany windows cracked or some broken outMasonry fell from block or brick wall(s)Old chimney, major damage or fell downModern chimney, major damage or fell downOutside wall(s) tilted over or collapsed completelySeparation of porch, balcony, or other addition from buildingBuilding permanently shifted over foundation

Additional Comments:

You may use the next box to clarify answers or to make observations that are not accommodated by other questions. You may also use the following box to give first-person descriptions of how the earthquake affected you. GSC scientists may use some of the information that you enter in qualitative descriptions of shaking or damage in GSC publications. You would be identified as "an observer" and your location would be given in general terms. Parts of some first-person accounts may be reproduced as quotations in GSC publications.